2014-05-08_HYDROLOGY - M1977300 - Laserfiche WebLink

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:r- v CD M 0 co C IIstody and Analytical Request Record PLEASE PRINT; provide as much Information as possible. Refer to corresponding notes on reverse side. Page .1 of 1 Company Name: Cotter Corporation Project Name: Sahwartt - Tracking No 7978 8138 3870 DATE:2/11 /14 SSTF: 527271, 527272 - Report Map Address: Sampler Name if other than Contact Cotter Corporation - Canon City Mill Contact Name: Frank Adamic 1- 303 -642 -3893 mine phone PO Box 1750; Canon City, CO 81215 -1750 voice: 1 -719- 275-7413 ext. 204 Bob Tennant 1- 719 -371- 3009 -cell Invoice Addrm: Invoice Contact JoAnne Ary Purchase Order#: ELI Quote #: PO Box 1750 Tel: 1- 719 - 275 -7413 ext. 209 Canon City, CO 81215 -1750 Fax: 1- 719 - 275 -1669 Report Required For: POTWA WVTP ❑ ANALYSIS REQUESTED Nobly ELI prior to RUSH sample Recelp p —Other Special Repo�CFormala — ELI must be notified c F t submittal for s additional charges ` C ::oo ID(s) prior to sample submittal for the foNowing: A � t and scheduling NEIAC ❑ �A2LA ❑ Level N ❑ Other � '? I Comments: Custody sal Y N' JEDD/EDT!rL F,artnat < CO Code - Intact, �.MLE ee gyy Table 1 Freq�!ency j 1, Y ! N Sure Y l M 4 4'�� Match LAB ID rote W, MATRIX > > Y / N Ir 1 SWAM 2111114 8:50 Water 1 ® ❑ ❑ ❑ O O D CU ❑ ❑ ® ❑ 2 SW-MIL 2111/14 9:10 Water 1 ® ❑ ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ® ❑ Z 3 ❑ ❑ ❑ ❑ ❑ ❑ D .❑ ❑ ❑ ❑ ❑ W 4 ❑ ❑ O ❑ D 13 . Cl ❑ ❑ 1 D ❑ ❑ 1 C 5 ❑ 1 ❑ D O ❑' O ❑ O ❑ 10 ❑ ❑ 1 }' 6 ❑ ❑ D ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ in ❑ 1 7 O' ❑ ❑ ❑ 10 ❑ ❑ ❑ ❑ ❑ ❑ ❑ a O ❑ ❑ ❑ ❑ ❑ D ❑ D ❑ ❑ O m o ❑ 0 o o❑❑❑ D D❑ 10 101010 ❑ ❑ D ❑ ❑ ❑ ❑ ❑ ❑ Custody Relwgfthed W. Bob Tennant D affirne:2/11 /1416:30 Shipped by: FedEx Received by: Dab&Time: UST Record b MUST be ReNnquished by. Date/Time: Shipped by: Received by: Datell'ime: 2�l Signed Sample Disposal: Return to Client ❑ lab Disposal ® LABO TORY USE ONLY Sample Type # of fre►q